For outpatient physical therapy practices
Your practice needs more than a submitted claim. It needs clear billing responsibilities, consistent follow-up, and someone who can explain where things stand.
William Avery brings eligibility, coding, claims, denial management, and reporting together. We begin with your payer mix, your systems, and the work your team needs help with.
Talk about your PT practiceA conversation about your practice. No obligation.
Physical therapy billing services
Our revenue cycle services cover the everyday work of billing and follow-up. For your PT practice, we define the responsibilities and escalation points before the first handoff.
A billing question about treatment time or medical necessity needs a documented answer from the responsible clinician. A billing partner should flag the gap and coordinate the next step, not infer care that was never documented.
The details that deserve a closer look
A useful billing conversation gets specific about your setting and your payers. These are checkpoints to discuss with a prospective partner; the applicable policy and clinical record determine each claim.
Time & units
Medicare uses total timed treatment minutes to determine billable timed units for a discipline and date of service. APTA advises checking commercial payer policy rather than assuming the same calculation applies everywhere. Keep timed and untimed services distinct in the review.
APTA: coding for timed codes ↗CMS: therapy documentation and units ↗Documentation
CMS identifies missing plans of care, certification, progress reports, and treatment time as outpatient therapy documentation problems. Agree on how the practice identifies outstanding documentation and returns it to the right clinician before a billing issue becomes a repeated delay.
CMS: outpatient therapy documentation ↗Therapy modifiers
For Medicare, GP identifies services under a physical therapy plan of care. CQ can apply to services furnished in whole or in part by a physical therapist assistant; CMS describes specific thresholds and exceptions. The modifier review needs the actual service and staffing details.
CMS: therapy modifier requirements ↗CMS: assistant modifier examples ↗Thresholds & edits
Medicare’s former outpatient therapy caps were repealed. KX documentation thresholds remain and are updated annually; they are not a fixed limit on covered visits. Separately, NCCI edits require a valid basis for any permitted modifier use, not an automatic modifier added to clear a denial.
CMS: current therapy thresholds ↗CMS: NCCI edits and modifiers ↗General operational information, not a determination of coverage or coding for a particular claim. Verify the payer’s current requirements and the policy applicable to your setting and date of service.
An example of a useful handoff
Illustrative workflow — not a client case study
A claim is denied for an authorization issue. Simply submitting it again does not explain whether the problem is the approval period, the service, the provider, or an exhausted allowance.
The useful deliverable is a clear status, a named owner, and a next action your team can understand. Explore our physical therapy denial management approach for the review workflow and checklist.
A checklist for practice owners
Ask each company the same questions, including us. Compare what the team will actually do, how you will see the work, and what your practice will still own.
| Compare | Ask the company | Request something concrete |
|---|---|---|
| PT billing workflow | How do you check timed units, therapy modifiers, and payer-specific requirements? | A walkthrough of the review process, including how documentation questions reach the therapist. |
| Authorization ownership | Who requests approval, counts remaining visits, and flags an expiring authorization? | A written division of responsibilities between the billing team and the practice. |
| A/R and denial follow-up | Who works old balances, and how is the next action recorded? | An example work queue with an owner, reason, last action, and next follow-up date. |
| Software and access | Can you support our exact EMR, billing setup, and clearinghouse? | A confirmed access plan, reporting workflow, and explanation of any migration requirements. |
| Reporting | How are your collection and denial metrics calculated? | A sample report with definitions, exclusions, and a way to trace totals back to claims. |
| Fees and exit terms | What is included, what is billed separately, and what happens when we leave? | A written fee schedule, scope of work, notice period, and data handoff process. |
Request a baseline before the transition. Review aging balances, denial reasons, collections, and unresolved tasks together. If a company quotes a clean-claim or denial rate, ask what it counts, what it excludes, and which period it covers. A percentage is more useful when you can connect it to the claims behind it.
Scope & pricing
Bring your payer mix, visit volume, software setup, and open A/R to the conversation. We’ll discuss the support you need and the responsibilities involved before you evaluate the engagement. Still deciding whether to outsource at all? Compare the costs in our outsourced physical therapy billing guide.
Discuss your billing needsMaking the transition
Changing billing support affects your front desk, clinicians, and financial reporting. Our onboarding approach starts with an agreed plan, and our data-handling standards address access and responsibilities.
Walk through your systems, payer mix, unresolved balances, and the work currently handled by your staff or billing vendor.
Agree on the service scope, access permissions, outstanding-claim ownership, and how documentation questions reach your team.
Compare the work received, claims submitted, payments, and remaining exceptions. Set a reporting cadence and a route for unresolved questions.
Confirm system compatibility and transition timing during scoping. Patient information should be exchanged only through the agreed secure process.
Before we talk
A billing company supports the administrative work between a therapy visit and payment. The agreed scope may include benefits verification, coding review, claim submission, denial follow-up, A/R, and reporting. Clarify responsibilities for authorizations, patient statements, credentialing, and old balances before signing; those tasks should never be assumed to be included.
We start by reviewing your existing systems and how your team uses them. Share the name of your EMR, billing platform, and clearinghouse during the introduction so we can confirm access, workflow, and reporting requirements before agreeing on the scope. Compatibility with a specific product needs to be confirmed.
Discuss your visit volume, payer mix, current billing workload, and any A/R backlog with us. The scope should be clear before you evaluate a quote. Ask how the fee is calculated, whether minimums or setup costs apply, and whether authorizations, statements, appeals, or historical balances create additional charges.
Yes. Bring a high-level description of the backlog and the issues taking up your team’s time. We can discuss the work involved and whether it belongs in the ongoing service scope or a separately defined project. Recovery depends on the individual claims, documentation, and applicable deadlines; it should not be assumed for every balance.
Do not assume that they do. APTA advises checking the payer’s policy when determining how timed services are billed. Medicare’s method and a payer’s application of the CPT midpoint convention can produce different unit calculations. Confirm the relevant policy before submitting the claim. APTA guidance on timed codes.
Your clinicians remain responsible for accurate documentation of the care delivered. Your team also needs to provide accurate registration information, respond to billing questions, and complete any front-office tasks retained in the agreement. The handoff should identify who owns authorizations, patient communication, documentation requests, and approvals.
Your practice size, software names, broad payer mix, and the billing problems you want to solve are enough to start. If helpful, describe how much of your team’s time goes into billing and what your current reports do not explain. Please do not put patient names, records, or claim details into Calendly; any record review needs an agreed secure process.
A partner for your practice
Tell us what is working, where billing gets stuck, and what you want a partner to take off your plate.
Choose a time on Calendly.
Please leave patient information out of your booking.
Prepared by William Avery. References checked .